Renal artery stenosis (RAS) is a potentially curable cause of hypertension and azotemia. Besides intra-arterial renal angiography there are several non-invasive techniques utilized to diagnose patients with suspicion of renal artery stenosis. Removing the stenosis by revascularization to restore unobstructed blood flow to the kidney is known to improve and even cure hypertension/azotemia, but is associated with a significant complication rate. To visualize renal arteries with x-ray techniques a contrast medium must be used. In a randomized, prospective study the complications of two types of contrast media (CO2 and ioxaglate) were compared. CO2 was not associated with acute nephropathy, but induced nausea and had lower attenuation differences compared to Ioxaglate. Acute nephropathy was related to the ioxaglate dose and the risk was evident even at very low doses if the patients were azotemic with creatinine clearance <40 ml/min. Evaluating patients for clinically relevant renal artery stenosis can be done utilizing several non-invasive techniques. MRA was retrospectively evaluated and shown to be accurate in detecting hemodynamically significant RAS. In a prospective study of 58 patients, evaluated with four methods for renal artery stenosis, it was shown that MRA and CTA were significantly better than ultrasonography and captopril renography in detecting hemodynamically significant RAS. The standard of reference was trans-stenotic pressure gradient measurement, defining a stenosis as significant at a gradient of ≥15 mmHg. The discrepancies were mainly found in the presence of borderline stenosis. The outcome of percutaneous revascularization procedures showed a technical success rate of 95%, clinical benefit in 63% of treated patients, 30-day mortality 1.5% and major complication rate of 13%. The major complication rate for patients with baseline serum creatinine >300µmol/l was 32%. Our results compare favorably with published studies and guidelines.

To ensure quality patient care hospitals invest in nursing intellectual capital by allocating financial, human and material resources for nurses to acquire the knowledge and skills necessary to provide safe patient care. This study’s purpose was to test selected propositions of the middle-range theory of nursing intellectual capital which provides a conceptualization of the influence of nurses’ knowledge, skills and experience (nursing human capital) to patient and organizational outcomes. The theory was systematically developed after a critical review of the literature. It proposes that nursing human capital (registered nurses’ experience, and knowledge and skills acquired from continuing professional development including university courses, conferences, workshops, in-services, specialty certification) is related to variables within the work environment (nurse staffing, employer support for nurse continuing professional development), which in turn, is associated with the quality of patient care (adverse events) and the recruitment and retention of nurses. The theory also proposes that nursing structural capital, nursing knowledge available within practice guidelines, is associated with the quality of patient care. A cross-sectional design was used to test the proposed relationships. The study took place in 6 acute care hospitals in two provinces of Canada. Financial, human resource and risk management data were collected from hospital departmental databases and a survey of unit managers. Data from 91 inpatient units were used with structural equation modeling to test the theory’s propositions. The results indicated that nurses’ knowledge and skills represented by the proportion of RNs with degrees and proportion of RNs with specialty certification were directly associated with low hospital-acquired infection rates. Nurse experience, measured as mean years RN professional experience and RN unit tenure, was found to be significantly related to higher RN recruitment and retention. The proportion of RNs with degrees was found to partially mediate the influence of nurse staffing on hospital-acquired infections. The results provide preliminary evidence of the association of nursing intellectual capital with patient and organizational outcomes. The findings may assist administrators with fiscal and human resource decision-making related to the education of nurses within acute care hospitals, and professional organizations with policies governing nursing education and continuing professional development.

To ensure quality patient care hospitals invest in nursing intellectual capital by allocating financial, human and material resources for nurses to acquire the knowledge and skills necessary to provide safe patient care. This study’s purpose was to test selected propositions of the middle-range theory of nursing intellectual capital which provides a conceptualization of the influence of nurses’ knowledge, skills and experience (nursing human capital) to patient and organizational outcomes. The theory was systematically developed after a critical review of the literature. It proposes that nursing human capital (registered nurses’ experience, and knowledge and skills acquired from continuing professional development including university courses, conferences, workshops, in-services, specialty certification) is related to variables within the work environment (nurse staffing, employer support for nurse continuing professional development), which in turn, is associated with the quality of patient care (adverse events) and the recruitment and retention of nurses. The theory also proposes that nursing structural capital, nursing knowledge available within practice guidelines, is associated with the quality of patient care. A cross-sectional design was used to test the proposed relationships. The study took place in 6 acute care hospitals in two provinces of Canada. Financial, human resource and risk management data were collected from hospital departmental databases and a survey of unit managers. Data from 91 inpatient units were used with structural equation modeling to test the theory’s propositions. The results indicated that nurses’ knowledge and skills represented by the proportion of RNs with degrees and proportion of RNs with specialty certification were directly associated with low hospital-acquired infection rates. Nurse experience, measured as mean years RN professional experience and RN unit tenure, was found to be significantly related to higher RN recruitment and retention. The proportion of RNs with degrees was found to partially mediate the influence of nurse staffing on hospital-acquired infections. The results provide preliminary evidence of the association of nursing intellectual capital with patient and organizational outcomes. The findings may assist administrators with fiscal and human resource decision-making related to the education of nurses within acute care hospitals, and professional organizations with policies governing nursing education and continuing professional development.

No description available.

The aims of this thesis were to investigate the long-term effects of adjuvant tamoxifen treatment on breast cancer recurrence and mortality, cardiovascular disease, and the incidence of secondary cancer. Between 1982 and 1992, postmenopausal patients with early stage breast cancer were included in a randomized clinical study of 2 or 5 years of postoperative tamoxifen therapy. The trial was planned by the Swedish Breast Cancer Group, and it included 4610 patients. Follow-up on causes of death, hospitalizations and secondary cancers were obtained from national population-based registries.  All-cause mortality, breast cancer-specific mortality and mortality from coronary heart disease were decreased in the 5-year group, but the incidence of endometrial cancer was increased (Paper I). The incidence and mortality of cerebrovascular diseases were increased during the active treatment phase, and reduced after the active treatment (Paper II). Similar results were seen for subgroups of cerebrovascular diseases such as stroke and ischemic stroke. In the 5-year group, the morbidity from coronary heart disease was reduced during treatment but not after treatment was stopped (Paper III). This was the case also for heart failure and for atrial fibrillation/flutter. For secondary cancers the lung cancer risk was reduced, as well as the lung cancer mortality (Paper IV). An increased risk was observed for endometrial cancer, but appeared to decrease over time. The risk of contralateral breast cancer was reduced, with most of the reduction after treatment was stopped. For distance recurrences the risk was reduced both during treatment and a few years after treatment was stopped. The breast cancer mortality was also reduced, especially during the post-treatment phase.

Fall er et stort og økende problem for eldre kvinner og menn i den vestlige verden. En rekke forskningsrapporter dokumenterer at det er mulig å forebygge fall, og tverrfaglige tiltak har vist størst effekt. Fallforebygging har derfor vært et satsingsområde i Stavanger kommune i en årrekke. Implementering av nye tiltak er krevende, og er det derfor viktig å undersøke i hvilken grad ny kunnskap har betydning for praksis. Studien bygger på teori om tverrfaglighet, salutogenese og coping fordi forståelse av disse begrepene er viktig for gjennomføring av tiltak. Hensikt med studien var å få mer kunnskap om forekomst og konsekvenser av fall blant pasienter i sykehjem og pasienter som får hjemmesykepleie. Dessuten var hensikten å få kunnskap om hvordan ansatte i sykehjem og hjemmesykepleie oppfatter fall, hvordan ansatte vurderer pasienters og pårørendes opplevelser etter fall og hva som i dag gjøres for å forebygge fall. Studien ble gjennomført som en todelt evaluering som bestod av en kvantitativ og en kvalitativ studie. Den kvantitative delen beskrev det enkelte fall, og personene som falt. Data fra fallregistreringsskjema fra 12 sykehjem og 5 hjemmebaserte tjenester, i en periode på fire måneder, ble analysert. I den kvalitative delen ble oppfølging av fall beskrevet og sammenlignet med fastsatte prosedyrer, retningslinjer og faglige normer, ved bruk av fokusgruppeintervju med ansatte i sykehjem og hjemmesykepleien. Det ble registrert 798 fall i perioden og av disse resulterte 170 i skade. Totalt falt 363 pasienter, 45 % av pasientene i sykehjem, og 6 % av pasientene som bodde hjemme. Alle ansatte gav utrykk for at det var viktig å redusere risiko for fall, og at tverrfaglig samarbeid var viktig. Ansatte gav også utrykkfor at det er lett å registrere fall og vanskelig ”å gjøre noe med det”. Dette bekreftes i resultat fra den kvantitative undersøkelsen der det ikke var dokumentert oppfølging for å hindre nye fall i 50 % av tilfellene. Miljøtilrettelegging var det tiltaket som oftest blir omtalt for å redusere fallrisiko for pasienter i hjemmet, for pasienter i sykehjem tilsyn. Pasientene ble i liten grad fulgt opp med individuell kartlegging og tverrfaglig innsats. For bedre implementering av forskningsbasert kunnskap innen fallforebygging er det nødvendig å identifisere målgruppen. Andre forbedringsområder er å ta hensyn til pasientenes erfaringer, fokusere på pasientenes egne ressurser og individuelle mestringstrategier. Ledere må i større grad legge til rette for tverrfaglighet, samt etterspør evaluering av tiltak rettet mot målgruppen. / Falls and fear of falling is a major and increasing problem for older males and females in the Western world. The effectiveness of falls prevention programmes is well documented and the multidisciplinary approach has been proven to be the most effective. For this reason the municipality of Stavanger has given priority to falls prevention programmes in the care for the elderly. The implementation of new models of care is challenging, it is therefore important to determine whether new techniques achieve good outcomes which in turn can influence how we deliver our service. The theory of this study is based upon understanding the concepts of a multidisciplinary approach, salutogenesis and coping, and how they impact on the implementation of falls prevention interventions. The objectives of this study were to obtain data about falls amongst patients in nursing homes and those patients receiving home care. To explore how the health professional documents and evaluates the patients’ and relatives’ experience after a fall, and to find out which falls prevention interventions are currently being utilised. A two part evaluation was chosen for this study. Part one outlines the fall description and the types of patients who fell. Part two reviews the interventions utilised after a fall and benchmarks them against recognised standards and procedures. Data gathered from 12 nursing homes and 5 home care units, using the fall registration form, over a period of four months, was analysed. Further information was obtained by conducting focus group interviews with the staff of nursing homes and home care units. During the period 798 falls were registered of which 170 falls resulted in injuries. A total of 365 patients fell, 45% of all patients in nursing homes and 6% of all patients receiving home care. All staff expressed the importance of reducing risk of falling, and providing multidisciplinary interventions. They gave the impression that it was easy to register falls, but difficult to follow up with interventions. This was supported with the results from the quantitative study, 50% of falls had no documentation of follow up. For patients living at home environmental changes were the most used intervention, for patients in nursing homes being looked after were most important. Individual assessment and multidisciplinary interventions were rarely carried out. For successful implementation of evidence based practice in falls prevention it is important to identify the target group. Other areas to be improved include the utilisation of patient assessments and ongoing evaluations with the focus on patients’ resources and individual coping strategies. Managers should ensure the adoption of the multidisciplinary team approach to interventions and implement regular assessments and evaluation of the target group / <p>ISBN 978-91-85721-33-7</p>

Base teórica: O surgimento de bactérias multirresistentes levou a uma renovação no interesse de antigos antimicrobianos, como a polimixina B, medicamento que foi descartado no passado devido sua toxicidade. Nas últimas duas décadas, esse antimicrobiano tornou-se um dos mais importantes agentes terapêuticos para o tratamento de infecções causadas por bactérias multirresistentes; porém, ainda faltam estudos clínicos que avaliem a segurança da polimixina B, especialmente em altas doses. Objetivo: Avaliar eventos adversos graves relacionados à infusão e a falência renal nos pacientes que receberam altas doses de polimixina B intravenosa. Métodos: Realizamos um estudo de coorte retrospectivo, multicêntrico. Incluímos pacientes que receberam > 3mg/kg/ dia ou uma dose total ≥250mg/dia de polimixina B, no período de janeiro de 2013 a dezembro de 2015. Para a avaliação dos eventos relacionados a infusão, foram incluídos pacientes que receberam ≥ 1 dose de polimixina B e para avaliação de falência renal incluiu apenas os pacientes que receberam ≥ 48 horas de polimixina B. Os desfechos principais avaliados foram os eventos adversos graves relacionados à infusão de acordo com os Critérios de Terminologia Comuns para Eventos Adversos (CTCAE v4.0) e a falência renal, utilizamos os critérios RIFLE (Risk, Injury, Failure, Loss and End stage), para categorizar os diferentes graus de lesão renal aguda. As variáveis incluídas no estudo foram as variáveis demográficas (idade, sexo), as variáveis individuais (peso, comorbidades, escore de Charlson), os fatores de gravidade (internação em UTI, uso de vasopressor, uso de bloqueador neuromuscular), outras fármacos nefrotóxicas, dose de polimixina utilizada (total, média diária e em mg/kg/dia), associação com outros medicamentos, e características da infecção (sítio, isolamento microbiológico) foram avaliadas em análise bivariada. Variáveis com P≤0.2 foram incluídas uma a uma, em ordem crescente, em modelo de regressão de COX. Variáveis com P< 0.1 permaneceram no modelo final. Resultados: Foram incluídos 222 pacientes para análise de eventos graves relacionados à infusão. A dose média de polimixina B foi de 3.61± 0.97 mg/kg /dia (dose total media = 268 mg/kg). Ocorreram eventos adversos graves relacionados à infusão em dois pacientes, determinando uma incidência bruta de 0.9% (intervalo de confiança de 95%, 0.2-3.2): um 7 evento classificado como um risco ameaçador a vida (efeito adverso classe IV) ocorreu em um paciente, homem, de 40 anos, internado no Centro de Terapia Intensiva, com fibrose cística, que recebeu 3,3 mg / kg / dia de PMB e desenvolveu dor torácica súbita, dispnéia e hipoxemia, no quarto dia de tratamento e o outro evento adverso grave (classe III), ocorreu em um paciente, homem, 23 anos, internado na enfermaria, com linfoma, que recebeu 3,6 mg / kg / dia de PMB , que apresentou parestesia perioral, tonturas e dispnéia no primeiro dia de tratamento. A falência renal foi analisada em 115 pacientes que receberam ≥ 48 horas de polimixina B e que não estavam em diálise no início do tratamento com Polimixina B; Falência renal foi encontrada em 25 de 115 (21,7%) pacientes expostos as PMB. Nosso estudo identificou que 54 [47,0%] pacientes desenvolveram algum grau de lesão renal aguda, pelos critérios de RIFLE: risco, 15 (27,8%), injúria, 14 (25,9%) e falência, 25 (46,3%) dentro das categorias do RIFLE. Além disso, droga vasoativa, outros fármacos nefrotóxicos e clearance de creatinina foram fatores de risco independentes para falência renal. Nem a dose diária de polimixina B ajustada para o peso corporal, nem a dose diária total foram associadas a falência renal. A mortalidade intra-hospitalar foi de 60% (134 pacientes): 26% (57 pacientes) morreram durante o tratamento e nenhum óbito foi durante a infusão. Conclusão: Altas doses de polimixina B no tratamento de infecções por bactérias gramnegativo apresentaram incidência baixa de eventos adversos agudos no nosso estudo e incidência de nefrotoxicidade elevadas, mas semelhantes a alguns estudos prévios com doses usuais”. Portanto, doses elevadas podem ser testadas em ensaios clínicos, objetivando melhorar os desfechos dos pacientes gravemente doentes com infecções por bactérias multirresistentes e minimizar o surgimento da resistência a polimixina B. / Background: The emergence of multiresistant bacteria has led to a renewal in the interest of old antimicrobials, such as polymyxin B, a drug that has been discarded in the past due to its toxicity. However, at this time, this antimicrobial has become one of the most important therapeutic agents for the treatment of infections caused by multiresistant bacteria but there is still a lack of clinical studies that evaluate the safety of polymyxin B, especially in relation to the use of high doses. This strategy, high doses, may be necessary in the fight against Gramnegative bacteria with a high minimum inhibitory concentration. Patients and methods: A retrospective, multicenter cohort study; the period evaluated was from January 2013 to December 2015, included patients who received > 3mg/kg/day or a total dose of ≥250mg/day of polymyxin B. The study included the evaluation of infusion-related events, patients who received ≥ 1 dose of polymyxin B and patients who received ≥ 48 hours of PMB were included for evaluation of renal failure. Major outcomes were serious adverse events related to infusion according to the Common Terminology Criteria for Adverse Events (CTCAE v4.0) and categorized renal failure by the RIFLE criteria (Risk, Injury, Failure, Loss, End stage). Factors potentially related to nephrotoxicity or mortality in 30 days were: demographic variables (age, sex), individual variables (weight, comorbidities, Charlson score), severity factors (ICU admission, use of vasopressor, use of Neuromuscular blocker), nephrotoxicity (other nephrotoxic drugs), polymyxin dose (total, daily mean and mg / Kg / day), association of drugs and infection characteristics (site and microbiological isolate) were evaluated in bivariate analysis. Variables with P≤0.2 were included one by one, in ascending order, in a Cox regression model. Variables with P <0.1 remained in the final model. Results: Two of 222 patients presented a severe infusion-related adverse event during PMB infusion, resulting in a crude incidence of 0.9% (95% Confidence Interval [CI], 0.2-3.2); one was classified as life-threatening and one classified as severe (crude incidence of each adverse event, 0.45%; 95% CI, 0.08-2.5). The life-threatening adverse effect occurred in an ICU patient (crude incidence among ICU patients, 0.67%; 95% CI, 0.12-3.7), a 40-years old male with cystic fibrosis who used 3.3 mg/kg/day of PMB and developed sudden thoracic pain, dyspnea and hypoxemia, in the fourth day of treatment. The severe adverse effect occurred in a non-ICU patient (crude incidence among non-ICU patients, 1.3%; 95% CI, 0.2-7.2), a 23- years old male with lymphoma exposed to 3.6 mg/kg/day of PMB, who presented perioral 9 paresthesia, dizziness and dyspnea in the first day of treatment. Renal failure was analysed in 115 patients who received ≥48 hours of PMB and who were not previously in dialysis. A total of 54 [47.0%] patients developed any degree of AKI, categorised as Risk [27.8%]; Injury [25.9%] and Failure [46.3%]) and 25 of 115 (21.7%) patients presented renal failure Vasoactive drug, concomitant nephrotoxic drugs and baseline creatinine clearance were independent risk factors for renal failure. Neither PMB daily dose scaled by body weight nor total daily dose were associated with renal failure. In-hospital mortality was 60% (134 patients): 26% (57 patients) occurred during treatment and none during infusion. Conclusion: Results suggest that high dose regimens have similar safety profile of usual doses and could be further tested in clinical trials assessing strategies to improve patients’ outcomes and minimize the emergence of PMB resistance.

Introdução: A busca pela qualidade e segurança é uma preocupação de instituições de saúde. A análise de risco é um dos caminhos para a melhoria da qualidade e minimização de eventos adversos nas organizações de saúde. A sessão de hemodiálise é um processo complexo e por esta característica pode estar submetida a uma alta incidência de erros, lapsos e falhas. Por isto, a preocupação com a segurança dos pacientes em diálise e conhecimento dos riscos a que estão suscetíveis é de extrema importância para o resultado e o sucesso do tratamento. Os Modos de Falha e Análise de Efeitos (FMEA) é uma ferramenta de análise prospectiva amplamente utilizada na engenharia industrial que tem sido aplicada em algumas instituições de saúde. Além disso, instituições acreditadoras sugerem que as revisões anuais sejam realizadas para a prevenção ativa de riscos em instituições hospitalares. Esta ferramenta pode ser usada para identificar possíveis falhas de sistemas ou processos, mesmo antes que eles aconteçam. Compreendendo a magnitude do problema e sua relevância, optamos por aplicar esta avaliação em uma unidade de hemodiálise em um hospital do sul do Brasil. Objetivos: Aplicar a ferramenta análise de modos de falha e seus efeitos em uma unidade de hemodiálise, a fim de conhecer os principais riscos e implementar sugestões de melhorias. Metodologia: Este é um estudo exploratório. Um estudo descritivo é descritivo no sentido de que FMEA é aplicado em uma Unidade de Hemodiálise de identificar os principais riscos do tratamento dialítico prospectivamente em um hospital filantrópico do Sul do Brasil. O instrumento foi aplicado por uma equipe multidisciplinar composta por nefrologistas, enfermeiros e gestores. Fase 1 - A escolha de um processo de risco; Fase 2 - Recrutamento da equipe multiprofissional; Fase 3 - Projetando o processo; Fase 4 - Identificar os modos de falha e seus efeitos; Fase 5 - Priorizar os modos de falha. Após a definição de cada modo de falha, a equipe estabeleceu a probabilidade de ocorrência do evento e sua classificação de acordo com a serveridade e frequência. A análise dos dados foi realizada com estatísticas.A metodologia utilizada para elaboração do FMEA foi a proposta pelo Institute for Healthcare Improvement em cinco etapas. A definição da Priorização de Risco foi calculada pelo Risk Profile Number (RPN). E a construção da matriz de riscos foi elaborada de acordo com a proposta do U.S Veterans Affairs. Resultados: Os principais resultados encontrados no estudo foram 41 modos de falha no processo. Destes, 12 foram considerados de alto risco com RPN (70-100) e estão relacionados aos cuidados com os acessos vasculares, falha na coleta de exames, confirmação de reações alérgicas que podem levar ao choque e cuidados com a punção e conexão das linhas na fístula arteriovenosa. Identificou-se 17 processos de médio risco com RPN (10-40), que foram relacionados à prescrição da hemodiálise e a ausência de verificação de sinais vitais. Os demais 12 modos de falha foram em processos de baixo risco com RPN (1-9). Conclusões: Os modos de falha encontrados em sua maioria não possuíam controles de processos atuais, em 36,6% dos processos, que são as chamadas barreiras para a ocorrência de eventos adversos e, portanto, foram sugeridas medidas de minimização do risco. / Introduction: The quality of care is a concern of Health Institutions. Risk analysis consists of complex actions for quality and safety of care. Routine hemodialysis session is a complex process and because these characteristics may be subjected to a high incidence of errors, lapses and failures. Concern for patient safety in dialysis and knowledge of the risks they are susceptible is of extreme importance for the outcome and treatment success. The Failure Modes and Effects Analysis (FMEA) is a prospective analysis tool widely used in industrial engineering that has been applied in some health institutions. In addition, the Joint Commission International (JCI) suggests that annual reviews be made for active prevention of risks in hospitalar institutions. This tool could be used to identify potential failures of systems or processes, even before they happen. Understanding the magnitude of the issue and its relevance, we choose to apply this evaluation in a hemodialysis unit in a South Brazil Hospital. Objective: To describe the application of FMEA in a Hemodialysis Unit Methods: This is an exploratory study. A Descriptive Study is descriptive in the sense that FMEA is applied in a Hemodialysis Unit to identify the main risks of dialytic treatment prospectively at a Philanthropic Hospital in the South of Brazil. The tool was applied by a multidisciplinary team composed of nephrologists, nurses and managers. Stage 1 – Choosing a Risk Process; Stage 2 – Recruiting the Multiprofessional Team ; Stage 3 – Designing the Process ; Stage 4 – Identifying the failure modes and their effects; Stage 5 – Prioritizing the failure modes: after defining each failure mode, the team established the probability of occurrence of the event and its severity. The classification of the failure mode took into account criticity, the frequency at which the event can occur, its severity, and to what extent it will be detected if it happens. The data analysis was based on descriptive statistics and according to the FMEA methodology. Results: The main results found in the study were 41 failure modes in the process, and 12 processes presented high risk RPN (70-100). This is related to the care of vascular accesses and failure in collection for tests, the confirmation of allergic reactions that may lead to shock, care with the puncture and connection of lines in the arteriovenous fistula. In the medium risk processes RPN (10-40) 17 were identified involving the prescription of hemodialysis and the absence of verification of vital signs. And the low risk RPN processes (1-9) were the other failure modes. Conclusion: analyzing the failure modes it was seen that most of the stages, 36.6% of the processes did not have controls of current processes which are the so-called barriers to the occurrence of adverse events, and therefore risk minimization measures were suggested.

Current status: The issue of medical errors has recently gotten considerable attention among organizations at the global and national levels. In its report the Institute of Medicine recommended the development of a safety culture where employees want to provide the safest health care. Assessing the current culture of safety is the first stage in the development of patient safety. Subject: The main purpose of the research was "to evaluate the safety culture in select hospitals." Method: A standardized method was chosen for the research: The AHRQ Hospital Survey on Patient Safety Culture. A quantitative method was implemented using polling. Obtained data were tested in SPSS version 16.0. For statistical testing Person's chi-square and sign scheme was elected. Research group: The research survey addressed 301 non-medical staff of Krajské zdravotní a.s. Masarykova nemocnice, o. z. (Regional Health a.s. Masaryk Hospital) in Ústí nad Labem and Krajské nemocnici Liberec, a.s. (Liberec Regional Hospital) Results: The survey results showed that the surveyed health care professionals assess the organizational culture as friendly. The respondents indicated that they are praised by the manager for conducting their work safely and that they can suggest changes in management practices. The results showed that addressed health care professionals support each other (58.1%) and cooperate better (72.4%). According to the respondents, better teamwork leads to better patient safety. An analysis of the results shows that health professionals have an active approach to safe care (82.7%) and in their opinion, errors and mistakes lead to improved patient safety (40.9%). Paramedics have confirmed that they receive feedback on reported incidents (37.9%). Based on team discussion about errors the respondents' evaluation of patient safety has significantly improved. An analysis of respondents' answers revealed a lack of reporting of adverse events. Most respondents consider the number of staff in the workplace deficient (42.5%). Conclusion: Hospital management should be involved in changing the detection of individual errors from individual to systemic. In order to improve the safety culture there should be regular supervision or teambuilding activities that support the development of teamwork. Feedback on the results of reporting errors must be given in an appropriate way to motivate staff to continue to report future errors. The results require a change in how medical staff report errors and greater consistency among management when checking reports. Complaints of work overload by medical personnel must be taken seriously. Improvements can be brought about by changes to work organization or the use of temporary workers.

Submitted by Kilvya Braga (kilvyabraga@hotmail.com) on 2018-05-16T13:56:30Z No. of bitstreams: 1 ADRIANO ARAÚJO SANTOS - TESE (PPGCC) 2016.pdf: 2344426 bytes, checksum: a867de6494509fd81bbcae390cd6bed4 (MD5) / Made available in DSpace on 2018-05-16T13:56:30Z (GMT). No. of bitstreams: 1 ADRIANO ARAÚJO SANTOS - TESE (PPGCC) 2016.pdf: 2344426 bytes, checksum: a867de6494509fd81bbcae390cd6bed4 (MD5) Previous issue date: 2016 / Diariamente, médicos especialistas analisam casos clínicos complexos e devem tomar decisões que podem afetar negativamente o bem estar de seus pacientes, os custos de procedimentos, o preço de seguros de saúde e a reputação dos especialistas e sistemas médicos envolvidos, ou até mesmo, serem fatais. A busca pela melhoria dos procedimentos na área de saúde, principalmente no intuito de mitigar os riscos de eventos adversos, tem se apresentado como um dos grandes desafios da atualidade, e o desenvolvimento de métodos e sistemas computacionais que auxiliam os especialistas no processo de decisão tem sido crescente no meio científico e empresarial. No tocante à presente pesquisa, o objetivo principal foi propor um modelo para auxílio à tomada de decisão em casos clínicos considerando diagnóstico coletivo, com a finalidade de mitigar os riscos e as incertezas enfrentados por especialistas médicos. A fim de avaliar a aplicabilidade de Anaís, dois produtos de software foram desenvolvidos e um experimento envolvendo 75 especialistas de saúde em formação profissional, organizados em 15 grupos, para resolver 15 casos clínicos, foi realizado. Os resultados obtidos foram estatisticamente significativos no que se refere à aplicabilidade do Anaís para o processo de mitigação de erros de decisão e enquanto ferramenta educacional, de acordo com opiniões dos participantes, atingindo, assim, o objetivo proposto na pesquisa. / Day after day, medical specialists analyze complex clinical cases and make decisions that can negatively affect their patients' well-being, procedure costs, health insurance costs, and the reputation of medical experts and systems involved, or even fatal. The search for better procedures in the health area, mainly in order to mitigate the risks of adverse events, has been presented as one of today's great challenges, and the development of computational methods and systems that help decision makers have been growing in the scientific and business environment. With regard to the present research, the main goal was to build a model to aid decision-making in clinical cases considering collective diagnosis. In order to evaluate the applicability of Anaís, two software products were developed and an experiment involving 75 healthcare specialists in professional training, organized in 15 groups to resolve 15 clinical cases were designed. Anaís has obtained statistically significant results of its possible applicability to the process of mitigation of decision errors and as an educational tool, according to the participants' opinions, thus reaching the objective proposed in the research.